nfrared thermography as a complementary method when diagnosing birth-related brachial plexus injury.

OBJECTIVES: The main objective of this study was to determine whether infrared thermography could be used as an efficient technique to evaluate the impact of a birth-related brachial plexus injury on the temperature of the injured arm and whether it could be used as a complementary method when diagnosing this injury in clinical praxis. BACKGROUND: Clinically, the brachial plexus injury is a peripheral paresis, which occurs when nerves that send signals from the spinal cord to the shoulder, arm, and hand are stretched or compressed. In principle, the brachial plexus injury, as a long-lasting injury, should be causing hypothermia of the injured arm. METHODS: The usage of contactless infrared thermography could offer a "new view" of the diagnostic process in this case. The present study, therefore, describes a process of clinical infrared thermography examination of three patients of different age and presents results from those examinations. RESULTS AND CONCLUSION: From our results, it can be confirmed that the birth-related brachial plexus injury affects the temperature of the affected arm, especially in the area of the cubital fossa, to an extent that the thermal camera is capable of detecting significant temperature differences between the healthy and injured arms (Tab. 3, Fig. 7, Ref. 13). Text in PDF www.elis.sk Keywords: birth brachial plexus injury, upper type palsy, peripheral palsy, infrared thermography.

Percutaneous Endoluminal Radiofrequency Ablation of Occluded Biliary Metal Stent in Malignancy Using Monopolar Technique: A Feasibility Study.

PURPOSE: To prove feasibility and safety of percutaneous endoluminal radiofrequency ablation (eRFA) using a monopolar approach in treatment of occluded biliary stent in malignancy. MATERIALS AND METHODS: The study included 11 patients with occluded biliary metal stent that had been implanted due to malignant biliary obstruction. All underwent metal stent recanalization by percutaneous eRFA in monopolar setting. Sixteen eRFA procedures were performed under fluoroscopic guidance with an EndoHPB 8F radiofrequency ablation catheter. The effect of stent recanalization was assessed based upon change from pre- to post-procedural diameter of the patent lumen of the metal stent (Wilcoxon test), primary and secondary stent patency (compared by log-rank test), catheter-free period, and overall survival. Adverse events were evaluated according to Common Terminology Criteria for Adverse Events (CTCEA) 4.0. RESULTS: Recanalization of the metal stent by monopolar radiofrequency ablation was successful in all 11 patients. Diameter of the patent lumen of the stent significantly widened after the eRFA inside the stent (median 2 vs. 7 mm, p = 0.003). Grade 1 complications were observed in one-third of procedures. Median stent patency after recanalization by eRFA was non-inferior to primary metal stent patency (154 vs. 161 days, p = 0.27). Median catheter-free survival and overall survival after stent recanalization were 149 and 210 days, respectively. CONCLUSION: Endoluminal radiofrequency ablation in monopolar setting was shown to be a feasible and safe method for recanalization of occluded biliary metal stents. LEVEL OF EVIDENCE: Level 4, Case Series.

Analysis of diffusion tensor measurements of the human cervical spinal cord based on semiautomatic segmentation of the white and gray matter.

BACKGROUND: Segmentation of the gray and white matter (GM, WM) of the human spinal cord in MRI images as well as the analysis of spinal cord diffusivity are challenging. When appropriately segmented, diffusion tensor imaging (DTI) of the spinal cord might be beneficial in the diagnosis and prognosis of several diseases. PURPOSE: To evaluate the applicability of a semiautomatic algorithm provided by ITK-SNAP in classification mode (CLASS) for segmenting cervical spinal cord GM, WM in MRI images and analyzing DTI parameters. STUDY TYPE: Prospective. SUBJECTS: Twenty healthy volunteers. SEQUENCES: 1.5T, turbo spin echo, fast field echo, single-shot echo planar imaging. ASSESSMENT: Three raters segmented the tissues by manual, CLASS, and atlas-based methods (Spinal Cord Toolbox, SCT) on T2 -weighted and DTI images. Masks were quantified by similarity and distance metrics, then analyzed for repeatability and mutual comparability. Masks created over T2 images were registered into diffusion space and fractional anisotropy (FA) values were statistically evaluated for dependency on method, rater, or tissue. STATISTICAL TESTS: t-test, analysis of variance (ANOVA), coefficient of variation, Dice coefficient, Hausdorff distance. RESULTS: CLASS segmentation reached better agreement with manual segmentation than did SCT (P < 0.001). Intra- and interobserver repeatability of SCT was better for GM and WM (both P < 0.001) but comparable with CLASS in entire spinal cord segmentation (P = 0.17 and P = 0.07, respectively). While FA values of whole spinal cord were not influenced by choice of segmentation method, both semiautomatic methods yielded lower FA values (P < 0.005) for GM than did the manual technique (mean differences 0.02 and 0.04 for SCT and CLASS, respectively). Repeatability of FA values for all methods was sufficient, with mostly less than 2% variance. DATA CONCLUSION: The presented semiautomatic method in combination with the proposed approach to data registration and analyses of spinal cord diffusivity can potentially be used as an alternative to atlas-based segmentation. LEVEL OF EVIDENCE: 1 Technical Efficacy: Stage 2 J. Magn. Reson. Imaging 2018;47:1217-1227.

Infrared thermal imaging: a potential tool used in open colorectal surgery.

Aim of this pilot study was to assess blood perfusion of bowel in resection lines by means of the infrared thermal imaging in order to choose the best place for anastomosis. The paper brings a first experience with infrared thermal imaging used in colorectal surgery operation from initial observation of the patient with T3 adenomatous carcinoma with no lymph node metastasis. The obtained infrared images show a clear boundary between parts of the intestine with blood perfusion and without it. The proposed position of resection of colon identified by infrared camera is in accordance with routinely designated position. Infrared thermal imaging seems to be a complimentary diagnostic method to see the perfusion in colorectal surgery.

Infrared thermography as option for evaluating the treatment effect of percutaneous transluminal angioplasty by patients with peripheral arterial disease.

Aim of this study was to evaluate the possible use of infrared thermography as a supplementary method to the ankle-brachial index used in assessing the treatment effect of percutaneous transluminal angioplasty. The study included 21 patients, mean age was 60.22 years. Healthy control group included 20 persons, mean age was 55.60 years. Patients with symptomatic peripheral arterial disease (Fontaine stages I-III) were admitted for endovascular treatment by percutaneous transluminal angioplasty. Thermal images and ankle-brachial index values were obtained before and after treatment by percutaneous transluminal angioplasty. Median temperature change in the treated limb was 0.4℃, for non-treated limb was -0.5℃. The median value of ankle-brachial index in the treated limb increased by 0.17 from 0.81 after the procedure. The median value of ankle-brachial index in the non-treated limb decreased by 0.03 from the value of 1.01. Significant difference between treated limb and non-treated limb in change of ankle-brachial index was found with p value = .0035. The surface temperature obtained by the infrared thermography correlates with ankle-brachial index. We present data showing that the increase of ankle-brachial index is associated with increase of skin temperature in the case of limbs treated by percutaneous transluminal angioplasty. Our results also suggest potential of the use of infrared thermography for monitoring foot temperature as a means of early detection of onset of foot ischemic disorders.

Using Noncontact Infrared Thermography for Long-term Monitoring of Foot Temperatures in a Patient with Diabetes Mellitus.

Foot complications in persons with diabetes mellitus (DM) are associated with substantial costs and loss of quality of life. Increasing evidence suggests changes in skin temperature, measured using an infrared thermographic system (IRT), may be a predictor of foot ulcer development in patients with DM. The purpose of this case study is to describe the long-term IRT findings and overall clinical outcomes of a patient with DM and peripheral vascular disease. Foot temperature measurements using IRT were obtained slightly more than 1 year before and immediately following endovascular treatment of a 76-year-old man, a nonsmoker with type 2 DM, hypertension, and ischemic heart disease with cardiac arrhythmia. Although he was otherwise asymptomatic, the infrared measurement showed an average temperature difference of 2.3˚ C between the left and right foot until he developed a small, trauma-induced wound on the left foot, at which time left foot temperature increased. He was diagnosed with rectosigmoid adenocarcinoma, underwent surgery and chemotherapy, and subsequently was evaluated for peripheral vascular disease. Before undergoing peripheral angiography and percutaneous transluminal angioplasty, IRT evaluation showed a hot spot on the left heel. Immediately following endovascular treatment, the mean temperature difference between the right and left foot was low (0.2˚ C), but a Stage I pressure ulcer was visible on the left heel. Skin breakdown in that area was observed 2 months later, and the wound continued to increase in size and depth. The patient died shortly thereafter due to complications of cancer. In this case study, a series of infrared images of foot skin temperatures appeared to show a relationship with blood circulation and wound/ulcer development and presentation. IRT has the ability to instantaneously measure the absolute temperature of the skin surface over a large area without direct skin contact. However, the devices are very sensitive and prospective clinical studies to determine the validity, reliability, sensitivity, and specificity of these measurements for routine use in patients who are at risk for vascular disease and/or foot ulcers are needed.

Effect of near field ultrasound on carboplatin treatment of ovarian carcinoma cells.

It has long been shown that therapeutic ultrasound has the potential to affect cells surfaces and membranes. In this study, the effects of ultrasound in near field mode, the anti-cancer drug carboplatin and their combined application were studied on human carcinoma cells A2780. Four modes of treatment were used: exposure to ultrasonic field, application of carboplatin, exposure to ultrasound followed by carboplatin and carboplatin treatment followed by exposure to near field ultrasound. The value of viability was measured by standard MTT test. The value of ultrasound intensity was set 1 W x cm(-2) and 1 MHz frequency was used. The real value of acoustic pressure during in vitro experiments was assessed by hydrophone. The results showed that a combined effect of ultrasound and carboplatin influenced the viability of human carcinoma cells A2780 more than the application of ultrasound or carboplatin alone. It could be assumed that exposure of cells to ultrasonic field had an immediate effect on the structure of cell surface and consequently on the entry of carboplatin into the cell. The results of our experiments demonstrated possibility of using therapeutic ultrasound in potentiating the cytostatic treatment of human carcinoma cells.

Ultrasound and cisplatin combined treatment of human melanoma cells A375--the study of sonodynamic therapy.

Sonodynamic therapy, an effect of low-power ultrasound field and the anticancer drug cisplatin, was studied in vitro on human melanoma cells A375. The viability of cells has been studied by standard 3-(4,5-dimethylthiazol-2-Yl)-2,5-diphenyltetrazolium bromide viability assay according to different modes of treatment: application of cisplatin alone, exposure of ultrasound field alone, exposure to ultrasound followed by cisplatin and application of cisplatin followed by exposure to ultrasound. Ultrasound was used at a therapeutic intensity of 1 W∙cm(-2) for 10 min. Concentration of cisplatin in the cell suspension was always 2.3 µM. The results show that sonodynamic therapy is one of the possibilities of how to intensify standard cytostatic therapy. This conclusion is supported by reducing the viability of studied cells, especially 72 h after the treatment. The time sequence of application of ultrasonic field and cytostatics appears to be a significant factor affecting the changes in cell viability. Maximum suppression of viability has been found when applying the experimental design involving application of cisplatin followed by exposure to ultrasound; the final value of viability of combined affected cells was more than 10% lower than for cisplatin treatment alone.

Determination of free cisplatin in medium by differential pulse polarography after ultrasound and cisplatin treatment of a cancer cell culture.

The in vitro study was carried out for detection of the cisplatin in free form and in culture medium, depending on various conditions of sonodynamic human ovarian cancer cells A2780 treatment by differential pulse polarography (DPP). For sonodynamic treatment, we used cisplatin alone and combined cisplatin/ultrasound treatments. The ultrasound exposure intensity of 1.0 and 2.0 W x cm(-2) in far field for incubation periods 1, 24 and 48 h was used. The parameters of DPP measurements were--1 s drop time, 5 mV x s(-1) voltage scan rate, 50 mV modulation amplitude and negative scanning direction; platinum wire served as counter electrode and Ag/AgCl/3 M KCl as reference electrode. The results showed the dependence of free platinum quantities in culture medium on incubation time and treatment protocol. We found difference in concentration of free cisplatin between conventional application of cisplatin and sonodynamic treatment. The sonodynamic combined treatment of cisplatin and ultrasound field showed a higher cisplatin content in the culture medium than cisplatin treatment alone; a difference of 20% was observed for incubation time 48 h. The results also showed the influence of a time sequence of ultrasound and cytostatics in the sonodynamic treatment. The highest amount of free cisplatin in the solution was found for primary application of cisplatin and the subsequent ultrasound exposure. The quantity of free cisplatin increased with time, namely for time intervals 1-24 h. There was no difference between the DPP signal of cisplatin in reaction mixture containing cells in small quantities and micro-filtered mixture without cells. Thus, the DPP method is suitable for the detection and quantification of free cisplatin in the culture medium of cell suspension. Ultrasound field can be important factor during cytostatic therapy.

Biological effects of combined ultrasound and cisplatin treatment on ovarian carcinoma cells.

The effects of low-power ultrasound, the anti-cancer drug cisplatin, and their combined application were studied in two lines of human ovarian carcinoma cells, A2780 and A2780cis. Four modes of treatment were used: exposure to ultrasonic field, application of cisplatin, exposure to ultrasound followed by cisplatin, and presence of cisplatin followed by exposure to application ultrasound. Ultrasound was used at intensities of 0.5 W/cm(2) and 1.0 W/cm(2) for 10 min, cisplatin was applied at concentrations of 1 microM and 6 microM per cell suspension treated in A2780 and cisplatin-resistant A2780cis cells, respectively. The results of each experimental treatment were assessed by the resultant cell viability related to the viability of control cells, using a standard MTT test. It was shown that a combined effect of ultrasound and cisplatin was more effective than that of ultrasound or cisplatin alone. It also appeared that the order of application played a role, with the cisplatin-ultrasound treatment lowering cell viability more than the ultrasound-cisplatin treatment. It can be assumed that the exposure of cells to a low-power ultrasonic field has an immediate effect on the structure of cell surfaces and, consequently, on entry of cisplatin into the cell. The study also included observations on changes in the cell cycle associated with the treatments used in both cell lines and their evaluation by flow cytometry.

Energetics, conformation, and recognition of DNA duplexes modified by methylated analogues of [PtCl(dien)]+.

In early studies of empirical structure-activity relationships, monodentate Pt(II) complexes were considered to be biologically inactive. Examples of such inactive monodentate Pt(II) compounds are [PtCl(dien)]+ (dien=diethylenetriamine) and [PtCl(NH3)3]+. DNA is considered the major biological target of platinum compounds. Thus, monodentate DNA binding of Pt(II) compounds was previously expected to display insignificant biological effects because it was assumed to affect DNA conformation and downstream cellular processes markedly less than the cross-links of bifunctional Pt(II) complexes. More recently it was shown that some monodentate Pt(II) complexes do exhibit biological effects; the active monodentate Pt(II) complexes commonly feature bulkier amine ligands than the hitherto used dien or NH(3) groups. We were therefore interested in determining whether a simple but marked enhancement of the bulkiness of the dien ligand in monodentate [Pt(NO3)(dien)]+ by multiple methylation of this ligand affects the early phases in which platinum compounds exert their biological activity. More specifically, the goals of this study, performed in cell-free media, were to determine how the modification of DNA duplexes by methylated analogues of [Pt(NO3)(dien)]+ affects their energetics and how the alterations of this biophysical parameter are reflected by the recognition of these duplexes by DNA polymerases and the DNA repair system. We have found that the impact of the methylation of [Pt(NO3)(dien)]+ on the biophysical properties of DNA (thermodynamic, thermal, and conformational properties) and its biochemical processes (DNA polymerization and the repair of DNA adducts) is remarkable. Hence, we conclude that monodentate DNA binding of Pt(II) compounds may considerably affect the biophysical properties of DNA and consequently downstream cellular processes as a result of a large increase in the bulkiness of the nonleaving ligands in this class of metal complex.